The foundation’s financial backing and the hospital’s operational turnaround have fortified Mount Sinai’s creditworthiness. Two credit rating agencies assigned investment-grade ratings to a $135 million bond issue in August by the Miami Beach Health Facilities Authority on behalf of Mount Sinai. The hospital used the proceeds to refinance older, more expensive bonds issued in 1998 and 2001.

Moody’s Investors Service assigned a Baa2 rating to Mount Sinai Medical Center’s fixed-rate bonds and cited, among other reasons, “the multi-year trend of improved financial performance that demonstrates the durability of MSMC’s recovery.” Fitch Ratings, which put a BBB rating on the $135 million bond issue, reported that Mount Sinai’s improved market position was a key factor: “Due to its excellent clinical reputation, the organization has been able to expand its reach in the market and maintain or improve clinical volumes and market share, particularly in cardiac services.”

Healthcare reform under the federal Affordable Care Act is a major challenge for Mount Sinai and the rest of the hospital industry. It is likely to reinforce downward pressure on the number of hospital-patient admissions, the length of hospital stays and the amount of reimbursement from patients’ insurers. A tighter squeeze on hospital finances, in turn, could ignite a new round of mergers and acquisitions in the industry.

Three hospitals in Miami Beach have closed in the last 20 years, leaving Mount Sinai as the city’s only one, and “there will be another consolidation of the market in the foreseeable future,” Sonenreich said. Asked if he expected Mount Sinai to acquire another hospital or be acquired, he suggested that the hospital would remain independent as long as its winning streak endures: “We expect to grow. Consolidation is all about winners and losers.”